HIV Prevention and Behavior Change in International Military Populations

The authors wish to thank the enlisted personnel, senior non-commissioned officers and commissioned officers of the Ghana Armed Forces who participated in an extensive field test of this training module in February 2001. Their contributions were invaluable in adapting the module to the practical learning environment in which it will be applied. We express special thanks to Colonel (Dr.) Frank A. Apeagyei, Director of the Ghana Armed Forces HIV/AIDS Prevention Programme, for his guidance and steadfast assistance in the planning and implementation of the field test.

There is a critical need to find effective ways to lower the risky behaviors that lead to infection with HIV and other sexually transmitted infections (STIs) in uniformed service populations (i.e., military, peacekeepers, police). Behavior change, based on acquiring knowledge and learning skills, along with individual risk assessment, is an effective method for reducing risky behaviors.

HIV poses a real threat to both uniformed service and civilian populations, especially during complex humanitarian emergencies including the descent into and emergence from crises involving armed confrontations. However, HIV prevention is not always the first thing on a service person’s mind in a conflict or crisis situation because the “guns are going” and they are preparing to be deployed into difficult, dangerous and stressful situations. Nevertheless, learning about HIV/STIs and prevention strategies is critical for every uniformed service member before being sent into a conflict or crisis situation.

Throughout the world, uniformed service personnel, including military and civilian police, are especially at risk for infection with HIV and other STIs. Duty often puts individuals in stressful situations and can also take them away from home for extended periods of time. The need to relieve stress, loneliness, and boredom can lead to risky behavior. Using alcohol and drugs to cope with stress can increase the incidence of risky behavior even more. Many uniformed service personnel are young and think that “nothing will ever hurt me.” To add to this type of thinking, uniformed service institutions encourage and value risk-taking and aggressiveness.

Men and women engaged in uniformed service work carry out admirable and important work, particularly in conflict and crisis settings. It is imperative that these individuals learn effective HIV/STI prevention strategies so they can protect their health and the health of civilian populations amidst whom they work and maintain the integrity of their missions.

This training-of-trainers module was developed for eventual integration within a larger training Curriculum that has been produced by the Civil-Military Alliance to Combat HIV and AIDS, in cooperation with the United Nations Department of Peacekeeping Operations (DPKO). This Curriculum presently consists of five training modules under the overall title HIV Prevention and Behavior Change in the Uniformed Services. Another module, "HIV Prevention for Women in Conflict and Crisis Settings," is now under preparation and will be added to the Curriculum later in the year 2001.

Within Module 7 in bolded text, appear special notes to instructors. These notes explain what the different sections of each module cover and their purpose, and provide instructions for specific exercises.

Training Trainers and Educators

To accompany the curriculum for Module 7, an overhead/slide set is included in Appendix B.These overheads/slides are primarily intended to serve as teaching aides when training other trainers and educators on how to use this curriculum. However, some of the overheads/slides might be appropriate for use in teaching this course to the target audience. Instructors can modify these visual aides depending on the needs of their audience(s).

Detailed information about training is included in Appendix A, Instructor’s Notes, which provides technical assistance to trainers and educators in implementing the curriculum and discusses the behavioral theories the curriculum is based upon. These notes serve as a guide for conducting the course and provide information that will help instructors to maximize the effectiveness of the curriculum.

Cultural Considerations

The information and activities included in Module 7 are based on the premise that HIV infection is preventable. However, effective prevention may require people to change their behavior, which is often deeply rooted in culture. Instructors for this course may have the opportunity to work with people from diverse cultural backgrounds and will be more effective in helping people to reduce their risk for HIV/STI infection if they are aware of the cultural dynamics that influence behavior. Instructors need to pay particular attention to sexual and drug-use behavior, including alcohol consumption, which can place individuals at risk for HIV/STI infection. It is also important to understand how participants choose to communicate about personal issues and their attitudes about seeking information and assistance.

The operating definition of “culture” used here is the shared values, norms, traditions, customs, arts, history, folklore and institutions of a group of people. These shared beliefs serve as guidelines for behavior within cultural groups. Culture is complex and dynamic – it helps people adjust to an always- changing environment. While cultural commonalties can be observed among groups of people, considerable variation can also be identified within groups based on factors such as age, education, gender and exposure to other cultures. It is therefore of little value to attempt to identify cultural characteristics for broad groups such as Asians, Africans or Europeans. The best approach for instructors is to be sensitive to and aware of the cultural issues that may be influencing the behavior of their participants. Instructors are also encouraged to explore these issues when conducting the training.

The following suggestions may be helpful to instructors when speaking about behavior change issues, particularly when participants are from cultures different from their own.

Listen =

Keep in mind that some people and cultures focus more on individualism, while others focus more on being members of a group (which might influence interaction and participation in the course). Also, individuals and cultures vary in their comfort level with self-disclosure, especially around issues related to sexuality, personal relationships and health.

How Module 7 Was Developed

Parts of Module 7 were developed utilizing a number of training curriculums for HIV/STD prevention and other sources including the: U.S. National Institute of Mental Health’s Project Light; U.S. Centers for Disease Control and Prevention’s Project Respect; Civil-Military Alliance to Combat HIV and AIDS’s Winning the War Handbook; U.S. Naval Health Research Center’s STD/HIV Intervention Program; U.S. Marine Corps HIV prevention training; American Red Cross’s HIV/AIDS Education Basic Fundamentals; U.S. Centers for Disease Control and Prevention’s and Georgetown University’s Simulated Patient Intervention Train-the-Trainer Manual; U.S. Department of Health and Human Service’s, Health Care Financing Administration’s Instructor’s Training Techniques; and United Nations Department of Peacekeeping Operation’s Protect Yourself, and Those You Care About, Against HIV and AIDS, Ten Rules: Code of Personal Conduct for Blue Helmets and We are United Nations Peacekeepers.

This module was field tested in Ghana with members of the Ghana Armed Forces, including male and female enlisted personnel, junior and senior non-commissioned officers and commissioned officers. Segments of Module 7 were developed in the field with members of the Ghana Armed Forces.

Course Summary and Rationale

This program will probably be like nothing you've done before. Throughout the program, we will be discussing sexual behavior that all people engage in. However, our special focus will be on how to engage in sexual activity safely, so you do not get infected or infect someone else with HIV or another sexually transmitted infection (STI).

Participant Guidelines

In order to meet the objectives of this course, we will discuss and explore some sensitive and personal issues. It is important to establish some basic guidelines to make sure that everyone has an opportunity to participate in the program and is treated with dignity and respect. Our expectation is that you will honor the following guidelines:

Confidentiality. Confidentiality means that any discussion that takes place in the context of this program should not be discussed with those who are not participating in the program. We will also abide by this rule. All that you say to us will be held in the strictest of confidence.

Honesty. Honesty means that you should speak from your own feelings and not just what you think people expect you to say. The honesty rule also applies to questions, because if we ask honest questions we won't waste time.

“I Statements.” “I” statements are statements that you make when you speak for yourself. Be accountable for yourself and do not speak for anyone else. Even though you may be friends, it is important that each of you speak for yourself and not your friend.

One at a Time. We cannot all be heard at the same time. Allow others to speak without interrupting them. Listen while others are speaking and do not participate in side conversations.

Respect. Treat all participants with dignity, and respect their feelings and opinions. We will not always agree, but everyone has a right to his or her beliefs and ideas. Do not ridicule or make fun of others. Any question or comment that is honest is valuable.

Take Care of Yourself. Take care of yourself by being aware of your feelings. If any of the issues we discuss are disturbing to you or make you curious, let the instructor know. If answering any question or taking part in any discussion or activity makes you feel uncomfortable, don't do it. Throughout the course, you can choose not to participate in any activity that makes you feel uncomfortable.

Getting to Know Each Other

Instructor Note: When a group is assembled for the purpose of acquiring skills related to HIV/STI prevention, individuals can at first be reserved or shy about discussing personal issues. “Getting to know each other” type of exercises can be useful exercises to warm up a group and get them better acquainted with each other. This type of activity often helps participants feel more comfortable, which ultimately enables them to get more out of the training. Two examples of these types of exercises follow.

Example 1

When You Were in Training (Basic, Officer or Specialist Training) Exercise

When you were in (basic, officer or specialist) training:

1) How old were you?

2) What were you like – were you shy, outgoing?

3) What was your living situation like – were you living in the barracks?

4) What did you do for fun?

5) Did you ever do something you were not supposed to do like date or see someone?

6) What was your instructor like?

7) What did you like the most about your training?

8) What did you like the least about your training?

1) Distribute “When You Were in Training” exercise sheet (see next page) to each participant. Modify the exercise sheet accordingly depending on your audience i.e., new recruits, officers, specialists.

2) Give participants three to four minutes to write answers. Emphasize they should not spend a lot of time thinking about the questions; first impressions are best.

3) Have participants talk in pairs for two to three minutes and switch partners two or three times.

4) Bring participants back into a large group and process the exercise with the following discussion questions. What was it like to go back to basic training? What differences do you see in yourself today? What differences are there among people in the group?

5) Did you ever do something you were not supposed to do like date or see someone?

Example 2

When You Were 16 Years Old Exercise

When you were 16 years old:

9) Where were you living?

10) What was your family like?

11) What was your community like?

12) What did you do for fun?

13) What was your favorite song?

14) Were you in love? With whom?

15) What did you look like?

16) What did you want to be when you grew up?

17) What were the social taboos (things that were not acceptable or appropriate) in your community?

18) What were the pressing social issues (sexuality, war, politics, etc.) for you or your community?

1) Distribute “When You Were 16 Years Old” exercise sheet to each participant.

2) Give participants three to four minutes to write answers. Emphasize they should not spend a lot of time thinking about the questions; first impressions are best.

3) Have participants talk in pairs for two to three minutes and switch partners two or three times.

4) Bring participants back into a large group and process the exercise with the following discussion questions. What was it like to go back? What differences do you see in yourself today? What differences are there among people in the group?

9) What were the social taboos (practices that are not allowed or acceptable) in your community?

To help men and women engaged in uniformed service work to learn about HIV, AIDS and STIs and how to promote good health.

· To educate participants about the kind of changes in behavior everyone needs to make in order to protect themselves and others from HIV/STI infection.

· To educate participants about complex emergencies, or crisis and conflicts, and how the complex emergency can place uniformed service personnel and civilians at risk for HIV/STI infection.

(1) To provide basic information on how HIV is transmitted, how it affects the immune system, AIDS and other STIs.

(2) To reinforce participant knowledge of risk factors for HIV/STI infection, awareness of personal risk factors and knowledge and skill in preventing the transmission of HIV and other STIs.

(5) To increase participant knowledge of the negative effects that alcohol and other drugs can have on decision-making, and how these substances can increase the likelihood of involvement in risky behaviors for HIV/STI transmission.

(6) To define the particular threat of HIV/STIs in pre- and post-crisis situations for uniformed service personnel (i.e., military, peacekeepers, police) as well as local civilian populations.

(7) To explore the relationship between sexual activity, STIs and HIV in crisis situations and their immediate aftermath.

(8) To increase participant awareness of the duty to protect themselves and civilian populations, not just from immediate harm, but also the threat of HIV/STIs

(9) To encourage participants to serve as peer educators, both for fellow uniformed service personnel and to local civilian populations.

(10) To review guidelines for professional conduct for uniformed service personnel and their implications for the prevention of HIV/STIs, particularly in crisis situations and their immediate aftermath.

(11) To encourage participants to make a personal commitment to reduce their risk for HIV/STIs and to reduce the risk for civilian populations which is their duty to protect.

(12) To teach participants how to serve as early-warning sentinels in pre-crisis situations, to identify deteriorating public health, socio-economic and political conditions and communicate that information to their chain of command and others.

Information and skills building exercises, group discussions, and interactive slide presentations.

· “Strategies for HIV Prevention and Behavior Change Exercise Instruction Sheet” for Exercise IV.A.

· “Strategies for HIV Prevention and Behavior Change Scenarios” for Exercise IV.A.

Instructor Note: All information in Module 7 is summarized on slides to assist with the presentation. Information to enhance the written curriculum (i.e., graphics) appears on slides/overheads and is indicated by a box next to the part of the curriculum it refers to.

This module is divided into two parts. Part I is a review of basic HIV/AIDS, STI information and HIV/STI prevention strategies. Part II discusses HIV/STI prevention in crisis settings.

I. Introduction

II. Facts about HIV Infection and AIDS, Information about STIs, Global Impact of HIV and the Impact of HIV on Uniformed Service Personnel and Institutions

Instructor Note: This section has an exercise to discuss HIV/AIDS facts and myths, a summary presentation of HIV/AIDS facts along with information about STIs, statistics on the global picture of HIV infection, and a discussion of the impact HIV has on uniformed services. Encourage participants to ask questions throughout the exercise, presentations and discussions.

Instructor Note: This exercise provides an overview of HIV and AIDS facts; tailor your comments to the needs of the group, depending on the level of their knowledge about HIV and AIDS.

1) Before the session, write each of the statements below on its own sheet of paper in large, easy-to-read letters (do not write Fact or Myth next to the statement). You can add to or eliminate the statements depending on your audience.

2) Tape two sheets of flip chart paper (one entitled “Facts”; the other “Myths”) on a wall where everyone can see them. Tell participants that the group is going to do an exercise in which they will separate facts about HIV and AIDS from myths. Go over what myth and fact mean with the participants.

3) In turn, read each statement written on paper aloud, asking if it is a myth or a fact and calling for volunteers to give the answer.

4) If the volunteer answers correctly, ask him/her to tape the sheet on the correct flip chart paper.

5) Reinforce the correct answer with additional information. If the participant does not answer correctly, acknowledge his or her effort and then give the right answer.

Instructor Note: If individual participation is or would be threatening to participants, you can run this as a group activity, asking the group to determine the answers.

Statement	Myth or Fact
HIV is the virus that causes AIDS.	Fact
You can get HIV by drinking from a glass used by someone who has HIV.	Myth
HIV is spread by kissing.	Myth
You can get HIV from a blood transfusion.	Fact (if the blood has not been screened for HIV))
Someone who has HIV but looks and feels healthy can still infect other people.	Fact
Drinking alcohol can increase the risk of getting HIV.	Fact
Mosquitoes can spread HIV.	Myth
Using a latex condom during sex can reduce the risk of getting HIV.	Fact
Having an implant in the arm for birth control can protect a woman from getting HIV.	Myth
Most people who get infected with HIV become seriously ill within one year.	Myth
Vaccination can protect people from HIV infection.	Myth
AIDS is a syndrome that has no cure.	Fact
A woman who has HIV can give HIV to her baby by breastfeeding.	Fact
You can get infected with HIV by scarification (markings on face an body), tattoos and body piercing.	Fact

Exercise Wrap Up

Instructor Note: Close this exercise by summarizing the following facts. You can also use this information to explain incorrect or incomplete information offered by participants during the Myths and Facts exercise and to address participant’s questions and concerns.

which is also referred to as the AIDS Virus. HIV is an extremely small virus, you cannot see it with your eye. It likes to be in dark, wet places like body fluids (blood, semen, vaginal fluid, breast milk). It is a fragile virus – when exposed to the air it dies in seconds. We will talk about how HIV gets into the body after we define AIDS.

A stands for acquired. It means that HIV is passed from one person who is infected to another person.

I is for immune and refers to the body's immune system. The immune system is made up of cells that protect the body from disease. HIV is a problem because once it gets into a person's body, it attacks and kills cells of the immune system.

D is for deficiency, which means not having enough of something. In this case the body does not have enough of certain kinds of cells, called immune cells that it needs to protect against infections. HIV enters the body and acts like a patient sniper, hidden for as long as it takes to do its job to weaken the immune system. Over time HIV kills more and more immune cells, the body's immune system becomes too weak to do its job and the person living with HIV becomes sick.

S means that AIDS is a syndrome. A syndrome is a group of signs and symptoms associated with a particular disease or condition that occur together. AIDS is a syndrome because people with AIDS have symptoms and diseases that occur together only when someone has AIDS.

· By having unprotected vaginal, anal, or oral sex with an HIV positive person.

Vaginal sex means a man inserting his penis into a woman’s vagina. Anal sex refers to a man putting his penis into the rectum, or anus, of a woman or a man. Oral sex means sucking or licking of the genitals – a man can suck or lick a woman’s genitals or a man’s penis; a woman can suck or lick a man’s penis or a woman’s genitals.

Vaginal sex can let HIV in your body through any cuts or tears inside the vagina or on the penis. HIV is contained in both semen and vaginal fluid, so a man can give HIV to a woman and a woman can pass HIV to a man. When a man is aroused, his penis stretches. Likewise, when a woman is aroused, her vagina stretches. This stretching makes the membranes in the penis and vagina more porous and causes very tiny cuts and breaks that you cannot see.

Anal sex can let HIV in your body through cuts or tears in the rectum, or anus. The rectum does not stretch readily (like the vagina) and because of this can tear and bleed more easily. A woman can contract HIV through semen when a man ejaculates in her rectum. A man can contract HIV through semen when a man ejaculates in his rectum.

Oral sex can let HIV in your body through any cuts or tears inside the mouth due to injury or gum disease. Often you cannot see or even be aware of cuts or tears inside your mouth. You can also have gum disease without your gums bleeding. Men can contract HV through vaginal fluid when performing oral sex on a woman or through semen when performing oral sex on a man. Women can contract HIV through semen when performing oral sex on a man or through vaginal fluid when performing oral sex on a woman.

· By sharing needles or syringes with an HIV positive person, getting tattooed or body pierced with a needle contaminated with HIV or receiving body scars or markings with a needle or knife contaminated with HIV. With tattoos or body scarification, the same needle or knife can be used among several people and not sterilized for each new person. If one person is HIV positive, infection can be spread.

· During pregnancy, birth or breastfeeding from an infected mother to her baby. During pregnancy, HIV can be passed from mother to baby through the placenta. At birth, HIV can be transmitted through blood from the birthing process. HIV is present in breast milk and can be transmitted to a baby during breastfeeding. The decision to breast feed if a mother is HIV positive is a difficult one only the mother can make. Current statistics say there is a 30% change a mother can transmit HIV to her baby by breastfeeding.

· By receiving a blood transfusion that is contaminated with HIV. Not all blood is routinely tested for HIV. In Ghana, blood is now routinely being tested for HIV. If contaminated with HIV, the blood is not used and is thrown away.

· Window period. Once a person becomes infected with HIV, that person does not immediately become “HIV positive.” There is a period of 3 to 6 weeks (sometimes as long as 3 – 6 months) before the body reacts to the presence of this virus and produces antibodies (chemicals) that can be found in the blood by laboratory tests. If these substances (antibodies) are found, the test result is “positive.” The period of time that passes while the test is still negative is called the “window period.” It is important to understand this, since the person can pass on the virus in these weeks, even through the HIV test is still negative.

· Asymptomatic period. After a person is infected with HIV, there is usually no change in that person’s health for quite a few years. The person feels well, is able to work as before and shows no signs of being sick (this is what is meant by “asymptomatic”). With the exception of having HIV in the body, the person is “fit for work.” This asymptomatic period varies from a few years to up to as many as 12 years. The average range is between 8 and 12 years. However, individuals can begin to become sick from a few to 5 years after infection.

· The symptomatic period when the person is sick with AIDS. Remember, AIDS is a “syndrome,” a collection of condition that, taken together, allow us to make a diagnosis of AIDS. Most of the conditions that start to appear are called “opportunistic infections” or OIs. OIs are caused by bacteria or viruses that normally do not cause illness in a person with a strong immune system, but do cause illness in a person with a weakened immune system. OIs are infections such as diarrhea, tuberculosis and pneumonia, and they repeatedly make the person sick. When a person is diagnosed with AIDS, the length of time until death can be very individual depending on the number and type of OIs and the availability of treatment and drugs. Individuals can live for 1-2 years or much longer (if receiving treatment with drugs).

· HIV testing as a prevention strategy. HIV testing is not a reliable prevention strategy because of the window period and asymptomatic infection (described above). However, if a couple wants to stop using condoms or have a family, both individuals can be tested for HIV at the same time and then use condoms with every sexual act (vaginal, oral or anal intercourse) for a 6-month period. They must agree to only have sex with each other and not sleep with anyone else. When the 6 months are over, the couple can get tested again for HIV at the same time. If both still test HIV negative, then they can start having sex without using a condom or try to get pregnant. Again, both individuals must agree to have sex only with each other and to not see anyone else.

· Through casual (non-sexual) social contact like shaking hands, touching or hugging, toilet seats or eating food fixed by someone living with HIV.

· By kissing. Some people are concerned about tongue kissing (French or deep kissing). HIV has been found in saliva, but the amount of HIV in saliva is extremely small. No one has ever contracted HIV by kissing.

· By mosquitoes. Mosquitoes are a problem and cause other diseases, but do not transmit HIV. We all tend to blame something else when it comes to HIV, so we blame things like mosquitoes. But this is too easy. The fact is that we give ourselves HIV and we alone can take precautions to prevent it.

You cannot get HIV from a mosquito, like you can malaria. HIV affects people mostly in the 15-49 year age group, while malaria affects mostly children aged 6 months to 8 years. It is clear that different populations are affected by HIV and malaria, and if mosquitoes transmitted HIV (like they do malaria), the same age group would be affected by HIV (the 6 month to 8 year old children).

Mosquitoes bite people for blood, which is their food. With malaria, a mosquito bites a person then goes into a 2-week life cycle to incubate the parasite. After this 2-week period, they then go and bite someone else, infecting them with malaria. This same situation does not happen with HIV because HIV cannot live within the mosquito for 2 weeks – it dies and the mosquito cannot transmit HIV when it bites another person.

· We are all at risk; anyone can become infected with HIV from one single unsafe sexual act or from using drugs by injection even just once.

· The vast majority of all HIV infections are caused by having unprotected intercourse with a woman or man who is already infected with HIV (70-80% of infections).

· There is no vaccine to protect people against getting infected with HIV. There is no cure for AIDS. This means that the only certain way to avoid AIDS is to prevent getting infected in the first place.

· Both men and women are vulnerable to infection from HIV and other sexually transmitted diseases, many of which have serious long-term consequences, especially for women e.g., pelvic inflammatory disease, tubal pregnancy, sterility.

· The presence of an untreated sexually transmitted infection (STI) like syphilis or gonorrhea facilitates the transmission of infection with HIV from one person to another. Open sores and blisters provide an easy entrance into the body for STIs, including HIV. Having an STI is already a sign of risky behavior. Prevention and treatment of STIs is another way to protect yourself against HIV infection.

· Drinking alcohol or using illegal drugs will reduce your judgment and your ability to act within the bounds of safe behavior. When you are under the influence of alcohol and/or drugs, you are more likely to indulge in risky sexual contacts.

· Being tattooed or body pierced or body scarred/marked with unsterile needles and knives/blades can result in infection with HIV and other STIs e.g., Hepatitis B. Make sure needles and knives are sterilized or try to use your own needles/knives/blades.

· Sexual transmission of HIV can be prevented by practicing safer sex. Safer sex includes not having sex, fidelity between uninfected partners, using a latex condom every time engaging in vaginal, anal, or oral sex, non-penetrative sex and engaging in activities such as hugging, kissing, masturbation, mutual masturbation.

Instructor Note: Present this information as a brief interactive discussion. Encourage questions from participants throughout the discussion.

There are many STIs. We will discuss Gonorrhea, Chlamydia, Syphilis and Genital Herpes.

Gonorrhea

· Gonorrhea is caused by intimate contact with the sexual organs, rectum or mouth of an infected person.

· Approximately 10-20 percent of males have no symptoms at all. In those who do, the first symptom is usually a burning pain when urinating and/or a discharge of pus from the penis. Symptoms usually occur 2-8 days after sexual contact, but they may occur as early as 1 day or as late as 30 days after contact.

· Most women do not notice that they have been infected since the infection generally begins high up in the cervical area. The discharge of pus, if present, may be mistaken for the normal vaginal discharge. There is usually no pain associated with this discharge, although some women may experience a slight burning sensation when urinating.

· Gonorrhea can be completely cured; however, it can be caught again, particularly if sex partners aren’t treated.

· If left untreated, gonorrhea can result in sterility, pelvic inflammatory disease (PID) in women which can lead to sterility and blindness in a baby if infected during birth.

Chlamydia

· Chlamydia trachomatis is a bacteria which causes significant genital infections in sexually active individuals, and eye and lung infections in infants born to infected mothers.

· The primary method of transmission is direct sexual contact with an infected person, usually sexual intercourse.

· Often Chlamydia shows no symptoms or can be mistaken for other STIs, such as gonorrhea. Men may have a discharge from the penis, a burning sensation when urinating, or pain in the testicles. Women may have an increased discharge from the vagina, a burning sensation when urinating, abnormal vaginal bleeding, abdominal pain, and a low-grade fever. Symptoms usually appear within 1-3 weeks after exposure to an infected person.

· Chlamydia can be completely cured; however, it can be caught again, particularly if sex partners aren’t treated.

· In men, untreated Chlamydia can lead to complications, such as inflammation of the eyes and skin lesions may also be associated with genital Chlamydial infection. The most common infection in women who do not receive treatment is an inflammation of the cervix. Chlamydia is also a major cause of pelvic inflammatory disease (PID). The consequences of PID include recurring pain, tubal pregnancies, infertility, and pelvic abscesses. Chlamydia can also cause inflammation of the tissues on the surface of the liver in both men and women.

· Newborns of mothers infected with Chlamydia may also develop pneumonia, infections of the eye, ear and other infections.

Syphilis

· Syphilis is a disease caused by a spiral shaped bacteria, and can involve every part of the body.

· Syphilis is spread through direct contact with the sexual organs, rectum or mouth of an infected person.

· In the early stages, syphilis may go unnoticed by the infected person. The first sign of syphilis is usually a single, small, firm, painless sore (chancre) at the site where the infection entered the body (penis, vagina, mouth). The chancre generally appears 10-90 days after contact with an infected person, and will last from 1-5 weeks. The second stage of syphilis occurs approximately 0-10 weeks after disappearance of the primary lesion. During this stage, the infected person may break out in a rash anywhere on the body. (The rash is unusual, because it appears identical on both the right and left sides of the body.) Most commonly, it appears on the palms of the hands and/or the soles of the feet. Rashes also go away but may reappear without treatment. This rash may be accompanied by fever, tiredness, sores in the mouth, or loss of hair. It is during these two stages (lasting up to one year) that the person is contagious.

· Syphilis can be completely cured; however, it can be caught again, particularly if sex partners aren’t treated.

· If Syphilis goes untreated, after the second stage the organism may remain dormant (be present in the body but causing no harm) for a length of time. After a period of time, the bacteria may begin to damage the brain, spinal cord, heart or other organs. This late stage (possibly occurring 2-25 years after stage one) can result in mental illness, paralysis, heart disease, blindness or death.

· A pregnant woman may transmit the disease to her unborn child if she has not been completely cured. Premature birth, miscarriage, stillbirth and

HIV Prevention and Behavior Change in International Military Populations

HIV Prevention in Crisis Settings

Pre-Field Test Draft

Project Manager

Rodger Yeager, Ph.D.

Civil-Military Alliance to Combat HIV and AIDS

Behavioral Scientist

Donna Ruscavage, M.S.W.

Henry M. Jackson Foundation for the Advancement of Military Medicine

March 2001

Training Trainers and Educators

Cultural Considerations

Listen =

How Module 7 Was Developed

Course Summary and Rationale

Participant Guidelines

Getting to Know Each Other

Example 1

When You Were in Training (Basic, Officer or Specialist Training) Exercise

Example 2

When You Were 16 Years Old Exercise

I. Introduction

Statement

Exercise Wrap Up

Gonorrhea

Chlamydia

Syphilis